What is back pain?

Back pain refers to pain that you may feel in your back or spine. It is a very common problem: 1 in 6 Australians report having back problems, and 4 out of 5 experience it sometime in their life. While both men and women report that they experience back problems, it is more commonly reported by people 25 years and older.

Back pain can be grouped into different categories. Lower back pain refers to pain felt in the lower part of the spine (the lumbar spine). Back problems can also affect the upper back (the thoracic spine), the neck (cervical spine) as well as the tailbone (coccyx).

People experience back pain in different ways. Some people say it feels like a sharp pain; other people report aches or spasms. You may feel stiff, or find it hard to turn or bend in certain directions. In some cases, such as sciatica, pain can travel down one or both your legs.

Back pain can impact you physically and mentally. People suffering from back pain may feel irritable or short-tempered. They may worry about whether the pain will control their life and may experience feelings of helplessness.

What causes back pain?

Your spine or backbone is a complex structure that is made up of 24 small bones called vertebrae that are stacked on top of each other. Discs sit between each vertebra to act as cushions or shock absorbers and give your spine flexibility. Vertebrae are joined together by small joints called ‘facet’ joints. These joints allow you to move and bend your back. A mesh of ligaments and muscles hold the spine together and provide structural support, which allows you to move.

Back pain can originate from any of these structures, but in most cases, this pain doesn’t result from any significant damage to your spine. This pain usually stems from surrounding muscles, ligaments or joints and occasionally spinal disc problems.

For at least 9 in 10 people, back pain is not caused by any particular condition and is referred to as non-specific back pain.

This type of back pain results from a range of different factors such as:

• poor posture
• weakness in back and abdominal muscles
• muscle strain or spasm
• extra pressure on the spine from sitting too long — for example, sitting in an office environment
• too little physical activity
• an unhealthy weight

Less than 1 in 100 people have back pain that is related to a serious medical problem such as cancer, infection, a spinal fracture or specific conditions such as ankylosing spondylitis. Research has also shown that you actually don’t need to know the cause of back pain to treat it successfully.

When should I see my doctor?

If you have back pain and have lost feeling or movement in your limbs or are having problems controlling your bowels or bladder, call triple 000 immediately and ask for an ambulance.

You should see your doctor or other health care professional for further advice if:

• your pain bothers you
• your back pain doesn’t improve after a few weeks or worsens
• you have symptoms such as weight loss, tingling or numbness in the legs, or problems with bladder and/or bowel control
• you have osteoporosis

You should see your doctor as soon as possible, if you have a history of cancer, are prone to infection, or use intravenous drugs.

For most people, back pain will resolve in a few weeks with appropriate self-care. After 2 months, 9 out of 10 people will recover from back pain.

How is back pain diagnosed?

Your health professional will first assess your back pain. They may ask questions including:

• When did your back pain begin?
• What activities were you doing differently to normal before your back pain started?
• How would you describe the pain? Is there tingling or numbness?
• What makes the pain better or worse?

If your pain doesn’t settle after a few weeks or starts getting worse, ask your doctor or other health care professional about other management options. You may be referred for tests if there is reason to suspect a more serious cause for your back pain.

In most situations, imaging such as X-ray, CT or MRI scans are not helpful unless there is an obvious injury or strain.

Unnecessary tests can be expensive, and many investigations will show changes in your spine that reflect the normal passage of time, rather than damage to your spine.

How is back pain treated?

You can do several things to manage back pain. A conversation with your doctor or physiotherapist can help address any concerns you may have and help you to better understand your treatment. Remember that not all information is trustworthy, so let your healthcare team know about treatments you are considering before you begin them.

Ways to manage back pain include the following:

• Keeping active — Try to return to some physical activity or regular work as soon as you can. Your back is designed to move, so don’t rest your back for more than a day or two.
• Physiotherapy — A qualified physiotherapist or exercise physiologist can suggest exercises to keep your back moving.
• Targeted training or exercise programs — Any exercise you enjoy can help manage back pain. Examples include Pilates, McKenzie therapy, the Alexander technique, sling exercise, graded activity exercise or motor control exercise.
• Acupuncture — Some studies show acupuncture can relieve back pain, but it is not clear how effective it is in the long term.
• Treatment by chiropractors or osteopaths — These health practitioners are often seen by patients for the relief of back pain
• Medication — Common pain relief medication such as paracetamol is not usually effective for back pain. Non-steroidal anti-inflammatories (NSAIDs) can provide a small reduction in back pain, but side effects may be a concern. If you take medication to manage back pain, use the lowest effective dose for the shortest time possible. For some people topical NSAIDs (such as a gel formulation) may be a safer option than NSAIDs in tablets.

Strong pain medication is not recommended for back pain. Research shows strong pain medication provides little benefit and can cause side effects such as drowsiness, sedation and/or dependence.

If you have severe back pain and your current medication is not adequately managing it, talk to your doctor about a suitable treatment plan. In some cases, your doctor may suggest an injection that can numb the pain such as an epidural injection, or a surgical procedure, such as a laminectomy to help manage your pain.

There are many other treatments to manage back pain, but they have not been well proven. These include:

• herbal medicines (such as cayenne, devil’s claw, white willow bark and comfrey)
• laser therapy
• ultrasound therapy
• heat and cold therapy (such as ice packs, hot water bottles)
• electrotherapy (such as transcutaneous electrical nerve stimulation or TENS)

How can back pain be prevented?

In most cases, you can prevent back pain by making changes to your lifestyle.

Doing exercise helps to keep your back flexible and strong. Exercise improves your posture and helps your muscles to support your spine. Exercises that can help prevent back pain include:

• low-impact aerobic exercise (such as walking, tai chi or swimming)
• strengthening exercises, such as lifting weights, climbing stairs or hiking hills
• stretching exercises, such as Pilates and yoga

Maintaining a good posture is important when you sit at home, in your workplace, or in your car. Try not to slouch, and use equipment that supports your back, such as a lumbar support or footstool if you need.

Keeping a healthy weight is also important. Excess fat can strain your back and lead to back pain, sciatica and inflammation.

Practise safe lifting in your home or workplace. Whenever you pick up a heavy load, squat down, hold the object close to your body, and lift with your legs.

In addition:

• Quit smoking — Smoking increases your chances of developing persistent back pain.
• Relax — Learning relaxation techniques and mindfulness can help to reduce stress and muscle tension in your back.
• Avoid high heels — wearing high heels can place strain on your back.

Can back pain lead to complications?

The good news is that most people recover from back pain within a few weeks.1 See your doctor if you experience additional symptoms, such as:

• loss of bowel and/or bladder control
• severe pain that gets worse instead of better over time
• problems with passing urine or bowel movements
• numbness or a ’pins-and-needles’ sensation in your legs, back or elsewhere
• unexplained weight loss
• back redness or swelling

For some people, back pain becomes an ongoing problem. Around 1 in every 2 people who experience back pain will experience it again, and for 1 in 5 people, back pain may last beyond 8 to 12 weeks. Possible complications that result from persistent, long-term back pain include:

• depression
• dependence on strong pain medicines, such as opioids
• reduced quality of life
• more difficulty finding work and keeping active

See your healthcare professional if your back pain is unresolved and limits your movement and activities. A health care professional can help you find ways to manage your pain and regain a better quality of life.

Resources and support

For more information and support, visit the Pain Australia website and find a support group or online community for people living with chronic pain.

Other languages

Do you prefer reading in languages other than English? The following websites offer translated information about back pain:

• The Hunter Integrated Pain Service (HIPS) has videos on understanding pain in several languages including Japanese, French, Portuguese and Norwegian.
• Multicultural Health Communication Service NSW has fact sheets on low back pain in Arabic, Chinese, Greek, Korean and Vietnamese.

Apps and tools

Pain Australia has suggested several apps that can help you understand and manage your pain better.